HealthBiz: Practice, patients need care

WASHINGTON, Nov. 26 (UPI) -- Consumer-driven healthcare will put more pressure than ever on physicians to provide good care for their businesses as well as for their patients.

Consumers shopping for healthcare services -- more cognizant of their choices and the cost of their care -- will force physicians in private practice to manage their offices better, to pay even more attention to their marketing, staffing, cash flow, capital expenditures and revenue. It's not something they particularly like to do, particularly if it takes away time they spend with patients. And it does -- so they fight it.

"Consumer driven healthcare is where we are and doctors have had to learn this, Max Reiboldt, chief executive officer of the Coker Group in Atlanta told UPI's HealthBiz. "Some of the younger ones sometimes have a little more of a hard time adapting to it than some who have been in practice longer and have seen cyclical changes take place."

A survey of 633 physicians this fall, from the Medical Practice Monitor by American Express, finds about half spend at least one full day each week managing the business end of their practice. For some, it was up to three days. Their biggest time-consumers are staffing and cash flow and the biggest challenge is managing malpractice insurance coverage. After that, traditional headaches such as slow insurance payments and accounts receivable kick in. More than 80 percent of those surveyed said they expected the challenges of running their practice would increase over the next few years.

The survey results are not new or surprising -- even from the 50 doctors who said if they had known when they were starting out what they know now about the difficulty of running a practice they wouldn't have chosen to practice medicine.

What is interesting from the survey is the growing realization that medical schools need to do a better job preparing physicians for the business aspect of their practice and that physicians already in practice need to rachet up their skills -- whether they like it or not.

Reiboldt said when he works as a consultant with physicians and physician practices all over the country he stresses "every little bit helps" as a better mantra than trying to achieve a total practice overhaul.

"You can't go in and provide them with the silver bullet -- that all of a sudden turn your practice from enabling you to make X to making X-plus in terms of income," he said. "But you can put in things -- small things that add up to an appreciable amount of money."

It can be as a simple as how a physician uses credit cards to manage cash flow. A hot topic is implementing office automation for billing, charting or data analysis. Increasing office staff training also can help by maximizing the abilities of each worker -- saving money by reducing the need for additional or more highly paid staff.

The goal is to keep up a high quality of care and yet not "come away with a sour taste" for the business side of medicine.

"That's becoming more and more of a challenge," Reiboldt said.

CANADIAN PHARMACIES FEELING THE SQUEEZE

Canadian pharmacies are in a no-win situation on different levels in the drug-importation controversy. On one hand, these pharmacies want to help out the elderly and uninsured in the United States who are at the mercy of some of the world's highest pharmaceutical prices. It's also a nice chunk of business they can handle.

On the other hand, Canadian pharmacies fervently wish their U.S. neighbors would deal with this mushrooming problem on their own so it doesn't overwhelm the system north of the border.

Six major pharmaceutical companies have blacklisted members of the Canadian International Pharmacy Association, the trade association representing 35 of Canada's leading mail-order pharmacies. CIPA pharmacies sell to about 2 million U.S. consumers with annual U.S. sales about $1 billion.

Drugmakers worried about their own U.S. markets and supply chains have stopped providing the big name medications to Canadian pharmacies that sell the product more cheaply than they are sold at American pharmacies.

"It's been quite effective in limiting if not totally cutting off our supplies," CIPA Executive Director David MacKay told HealthBiz.

The U.S. government has said it cannot support reimportation of drugs from Canada because of safety issues, but many critics contend the Bush administration simply is succumbing to pressure from Big Pharma. Most recently, Canadian Health Minister Ujjal Dosanjh said he would seek to change the Canadian Food and Drug Act to prevent Canadian physicians from authorizing U.S. prescriptions without first examining the patient.

"The Canadian federal government has weighed in on this issue publicly while before they were neutral or rather silent," MacKay said.

He said it is no small coincidence this newly vocal Canadian opposition arose only after the November U.S. presidential election resulted in the re-election of President Bush.

"As soon as President Bush gets a fresh mandate -- automatically the Canadian government voices its opinion -- after four years," MacKay said. He said the common element is Big Pharma pressure with the Canadian announcement delayed to ensure it didn't create a bigger campaign issue among supporters of importation.

Ironic, but though Canadian pharmacies want to help, they do not want to become the biggest U.S. pharmacy. MacKay said Canadian pharmacies control only one-half of a percent of the U.S. market -- and "we don't intend to service 250 million" people.

There were talks with the presidential campaign of Democrat John Kerry over concern a Kerry presidency would usher in legalized wholesale importation that would turn CIPA's 2 million customers into 100 million customers overnight.

"That would be impossible," MacKay said. "At this point, we're opposed to any (U.S.) legalization if it includes wholesale. It would open up too big of a pipeline. Legalized mail order we could handle."

MacKay said an adequate drug supply for Canadians is a top priority so CIPA members are not entering into direct contracts with city or state governments in the United States or any entity that pays for drugs on behalf of a patient or group of patients.

As it stands now, however, MacKay said pharmacists are alarmed over Dosanjh's proposal, which would make it illegal for Canadian physicians to re-write U.S. prescriptions -- the practice now employed to allow Canadian drugs to be dispensed via mail order across the border -- unless they first examine the patient. Another idea floating around is to use license revocation as a threat to keep physicians from providing this mail-order service.

MacKay said removing the Canadian physician from the mix puts Canadian pharmacies out of the U.S. mail-order business. That would cost 5,000 jobs and be a huge blow to Western Canada's economy.

MacKay said Manitoba at one point was ready to eliminate the physician from the entire process but "we're caught in a 'Catch 22.' This process saves lives. We're catching mistakes, problems with the prescriptions."

One potential answer would be to have reciprocal physician validation -- U.S. physician prescriptions would be honored in Canada as legitimate and visa versa. Another would restrict how many prescriptions Canadian physicians could write for U.S. buyers.

MacKay said he wants a summit where all Canadian players -- pharmacists, physicians, government regulators and pharmaceutical interests -- can work out a compromise. That is not likely anytime soon.

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